1
|
Hu Y, Gordon N, Ogg K, Kraitchman DL, Durr NJ, Surtees B. Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System. Bioengineering (Basel) 2024; 11:391. [PMID: 38671812 PMCID: PMC11048087 DOI: 10.3390/bioengineering11040391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/05/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
To investigate the potential of an affordable cryotherapy device for the accessible treatment of breast cancer, the performance of a novel carbon dioxide-based device was evaluated through both benchtop testing and an in vivo canine model. This novel device was quantitatively compared to a commercial device that utilizes argon gas as the cryogen. The thermal behavior of each device was characterized through calorimetry and by measuring the temperature profiles of iceballs generated in tissue phantoms. A 45 min treatment in a tissue phantom from the carbon dioxide device produced a 1.67 ± 0.06 cm diameter lethal isotherm that was equivalent to a 7 min treatment from the commercial argon-based device, which produced a 1.53 ± 0.15 cm diameter lethal isotherm. An in vivo treatment was performed with the carbon dioxide-based device in one spontaneously occurring canine mammary mass with two standard 10 min freezes. Following cryotherapy, this mass was surgically resected and analyzed for necrosis margins via histopathology. The histopathology margin of necrosis from the in vivo treatment with the carbon dioxide device at 14 days post-cryoablation was 1.57 cm. While carbon dioxide gas has historically been considered an impractical cryogen due to its low working pressure and high boiling point, this study shows that carbon dioxide-based cryotherapy may be equivalent to conventional argon-based cryotherapy in size of the ablation zone in a standard treatment time. The feasibility of the carbon dioxide device demonstrated in this study is an important step towards bringing accessible breast cancer treatment to women in low-resource settings.
Collapse
Affiliation(s)
- Yixin Hu
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Naomi Gordon
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Katherine Ogg
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| | - Dara L. Kraitchman
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Nicholas J. Durr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA;
| | - Bailey Surtees
- Kubanda Cryotherapy, Inc., Baltimore, MD 21211, USA; (Y.H.); (N.G.); (K.O.)
| |
Collapse
|
2
|
de Ruiter QMB, Mauda-Havakuk MM, Starost MF, Bakhutashvili I, Esparza-Trujillo JA, Brown A, Natesan H, Kveen G, Lewis AL, Wood BJ, Pritchard WF, Karanian JW. Image-Guided Transbronchial Pulmonary Cryoablation with a Flexible Cryoprobe in Swine: Performance and Radiology-Pathology Correlation. J Vasc Interv Radiol 2024:S1051-0443(24)00268-9. [PMID: 38599280 DOI: 10.1016/j.jvir.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/30/2024] [Accepted: 02/24/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To evaluate the performance of a prototype flexible transbronchial cryoprobe compared with that of percutaneous transthoracic cryoablation and to define cone-beam computed tomography (CT) imaging and pathology cryolesion features in an in vivo swine model. MATERIALS AND METHODS Transbronchial cryoablation was performed with a prototype flexible cryoprobe (3 central and 3 peripheral lung ablations in 3 swine) and compared with transthoracic cryoablation performed with a commercially available rigid cryoprobe (2 peripheral lung ablations in 1 swine). Procedural time and cryoablation success rates for endobronchial navigation and cryoneedle deployment were measured. Intraoperative cone-beam CT imaging features of cryolesions were characterized and correlated with gross pathology and hematoxylin and eosin-stained sections of the explanted cryolesions. RESULTS The flexible cryoprobe was successfully navigated and delivered to each target through a steerable guiding sheath (6/6). At 4 minutes after ablation, 5 of 6 transbronchial and 2 of 2 transthoracic cryolesions were visible on cone-beam CT. The volumes on cone-beam CT images were 55.5 cm3 (SE ± 8.0) for central transbronchial ablations (n = 2), 72.5 cm3 (SE ± 8.1) for peripheral transbronchial ablations (n = 3), and 79.5 cm3 (SE ±11.6) for peripheral transthoracic ablations (n = 2). Pneumothorax developed in 1 animal after transbronchial ablation and during ablation in the transthoracic cryoablation. Images of cryoablation zones on cone-beam CT correlated well with the matched gross pathology and histopathology sections of the cryolesions. CONCLUSIONS Transbronchial cryoablation with a flexible cryoprobe, delivered through a steerable guiding sheath, is feasible. Transbronchial cryoablation zones are imageable with cone-beam CT, with gross pathology and histopathology similar to those of transthoracic cryoablation.
Collapse
Affiliation(s)
- Quirina M B de Ruiter
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Michal M Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Interventional Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matthew F Starost
- Division of Veterinary Resources, National Institutes of Health, Bethesda, Maryland
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Juan A Esparza-Trujillo
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Andrew Brown
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | | | - Graig Kveen
- Boston Scientific (formerly BTG), Arden Hills, Minnesota
| | - Andrew L Lewis
- Boston Scientific (formerly BTG), Arden Hills, Minnesota; Alchemed Bioscience Consulting Ltd, Farnham, Surrey, United Kingdom
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland; Center for Cancer Research, National Institutes of Health, Bethesda, Maryland
| | - William F Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - John W Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
3
|
Esparza-Trujillo JA, Pritchard WF, Mauda-Havakuk M, Starost MF, Wakim P, Zeng J, Mikhail AS, Bakhutashvili I, Wood BJ, Karanian JW. Imaging and Pathologic Evaluation of Cryoablation of Woodchuck ( Marmota monax) Hepatocellular Carcinoma. Comp Med 2023; 73:127-133. [PMID: 36914240 PMCID: PMC10162372 DOI: 10.30802/aalas-cm-22-000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 12/10/2022] [Indexed: 03/16/2023]
Abstract
We characterized cryoablation as a mode of clinical intervention in adult woodchucks with hepatocellular carcinoma (HCC). Woodchucks (n = 4) were infected with woodchuck hepatitis virus at birth and developed LI-RADS-5 hypervascular HCC. At 21 mo of age, they underwent ultrasound (US), contrast-enhanced CT (CECT) imaging, and US-guided subtotal cryoablation (IcePearl 2.1 CX, Galil, BTG) of their largest tumor (Mean HCC volume of 49 ± 9 cm³). Cryoablation was performed using two 10-min freeze cycles, each followed by an 8-min thaw cycle. The first woodchuck developed significant hemorrhage after the procedure and was euthanized. In the other 3 woodchucks, the probe track was cauterized and all 3 completed the study. Fourteen days after ablation, CECT was performed, and woodchucks were euthanized. Explanted tumors were sectioned using subject-specific, 3D-printed cutting molds. Initial tumor volume, the size of the cryoablation ice ball, gross pathology and hematoxylin and eosin-stained tissue sections were evaluated. On US, the edges of the solid ice balls were echogenic with dense acoustic shadowing and average dimensions of 3.1 ± 0.5 × 2.1 ± 0.4 cm and cross-sectional area of 4.7 ± 1.0 cm². On day 14 after cryoablation, CECT of the 3 woodchucks showed devascularized hypo-attenuating cryolesions with dimensions of 2.8 ± 0.3 × 2.6 ± 0.4 × 2.93 ± 0.7 cm and a cross sectional area of 5.8 ± 1.2 cm². Histopathologic evaluation showed hemorrhagic necrosis with a central amorphous region of coagulative necrosis surrounded by a rim of karyorrhectic debris. A rim of approximately 2.5 mm of coagulative necrosis and fibrous connective tissue clearly demarcated the cryolesion from adjacent HCC. Partial cryoablation of tumors produced coagulative necrosis with well-defined ablation margins at 14 d. Cauterization appeared to prevent hemorrhage after cryoablation of hypervascular tumors. Our findings indicate that woodchucks with HCC may provide a predictive preclinical model for investigating ablative modalities and developing new combination therapies.
Collapse
Affiliation(s)
| | - William F Pritchard
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| | | | - Paul Wakim
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Johnathan Zeng
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| | - Andrew S Mikhail
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
- Center for Cancer Research, and
| | - John W Karanian
- Center for Interventional Oncology, Radiology & Imaging Sciences, Clinical Center
| |
Collapse
|
4
|
Dolganova IN, Zotov AK, Safonova LP, Aleksandrova PV, Reshetov IV, Zaytsev KI, Tuchin VV, Kurlov VN. Feasibility test of a sapphire cryoprobe with optical monitoring of tissue freezing. JOURNAL OF BIOPHOTONICS 2023; 16:e202200288. [PMID: 36510652 DOI: 10.1002/jbio.202200288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/22/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
This article describes a sapphire cryoprobe as a promising solution to the significant problem of modern cryosurgery that is the monitoring of tissue freezing. This probe consists of a sapphire rod manufactured by the edge-defined film-fed growth technique from Al2 O3 melt and optical fibers accommodated inside the rod and connected to the source and the detector. The probe's design enables detection of spatially resolved diffuse reflected intensities of tissue optical response, which are used for the estimation of tissue freezing depth. The current type of the 12.5-mm diameter sapphire probe cooled down by the liquid nitrogen assumes a superficial cryoablation. The experimental test made by using a gelatin-intralipid tissue phantom shows the feasibility of such concept, revealing the capabilities of monitoring the freezing depth up to 10 mm by the particular instrumentation realization of the probe. This justifies a potential of sapphire-based instruments aided by optical diagnosis in modern cryosurgery.
Collapse
Affiliation(s)
- Irina N Dolganova
- Osipyan Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - Arsen K Zotov
- Osipyan Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | | | - Polina V Aleksandrova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Igor V Reshetov
- Institute for Cluster Oncology, Sechenov University, Moscow, Russia
| | - Kirill I Zaytsev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Valery V Tuchin
- Science Medical Center, Saratov State University, Saratov, Russia
- Institute of Precision Mechanics and Control, FRC "Saratov Scientific Centre of the Russian Academy of Sciences", Saratov, Russia
- Tomsk State University, Tomsk, Russia
| | - Vladimir N Kurlov
- Osipyan Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| |
Collapse
|
5
|
Pushkarev AV, Ryabikin SS, Saakyan NY, Tsiganov DI, Burkov IA, Vasilev AO. A study of prostate multiprobe cryoablation near urethra for precision treatment planning. Cryobiology 2022; 109:10-19. [PMID: 36283423 DOI: 10.1016/j.cryobiol.2022.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/14/2022] [Accepted: 10/15/2022] [Indexed: 02/06/2023]
Abstract
The simplified preoperative planning of multiprobe prostate cryoablation limits its efficiency. In order to improve it, the thermal history prediction software is being developed. However, the problem of high risks at the prostate-urethra boundary has not been solved yet. The urethral warming system is used to protect the urethral canal from freezing. On the one hand it is used to reduce the risk of damage to the urethra; on the other hand it increases the risk of insufficient ablation of the tumor. This paper presents a step towards the possibility of carrying out the precision prostate cryoablation in this region. For the experimental part, three cases of arrangement of one and two argon cryoprobes and a heating catheter have been considered. Freezing zone shape and dimensions, and temperature at control points depending on time have been obtained. Experimental results have clearly shown the effect of the heating catheter, the second cryoprobe, and the initial temperature of the biotissue phantom on the freezing zone. After, the thermal aspects of treatment simulation have been developed and verified. A series of calculations have been carried out with the goal to get the information about optimizing the prostate cryoablation on the prostate-urethra boundary. The arrangement of cryoprobes has been proposed for three different variants for prostate cryoablation (sectors of 90, 180° and 360°). The area of prostate tissues near the urethra that cannot be cooled below the necrosis temperature is shown. This information is expected to be useful for improving the quality of cryosurgery planning algorithms (e.g. for tumor treatment).
Collapse
Affiliation(s)
- A V Pushkarev
- Bauman Moscow State Technical University, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
| | - S S Ryabikin
- Bauman Moscow State Technical University, Moscow, Russia
| | - N Yu Saakyan
- Bauman Moscow State Technical University, Moscow, Russia
| | - D I Tsiganov
- Bauman Moscow State Technical University, Moscow, Russia; Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - I A Burkov
- Bauman Moscow State Technical University, Moscow, Russia
| | - A O Vasilev
- Bauman Moscow State Technical University, Moscow, Russia; Department of Urology, Moscow State University of Medicine and Dentistry n.a. A.I. Evdokimov, Moscow, Russia
| |
Collapse
|
6
|
Ranjbartehrani P, Etheridge M, Ramadhyani S, Natesan H, Bischof J, Shao Q. Characterization of Miniature Probes for Cryosurgery, Thermal Ablation, and Irreversible Electroporation on Small Animals. ADVANCED THERAPEUTICS 2022. [DOI: 10.1002/adtp.202100212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Pegah Ranjbartehrani
- Department of Mechanical Engineering University of Minnesota Minneapolis MN 55455 USA
| | - Michael Etheridge
- Department of Mechanical Engineering University of Minnesota Minneapolis MN 55455 USA
| | | | | | - John Bischof
- Department of Mechanical Engineering University of Minnesota Minneapolis MN 55455 USA
- Department of Biomedical Engineering University of Minnesota Minneapolis MN 55455 USA
| | - Qi Shao
- Department of Mechanical Engineering University of Minnesota Minneapolis MN 55455 USA
| |
Collapse
|
7
|
Srivastava P, Kumar A. Optimizing the spray parameters of a cryospray process. Cryobiology 2020; 98:201-209. [PMID: 33171196 DOI: 10.1016/j.cryobiol.2020.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Abstract
Smaller spray zone of single-hole nozzle (SHN) constrains cryospray as a treatment method suitable for lesions having diameter larger than 15 mm on the skin surface. The present study is an attempt to resolve this issue, through the improvement in conventional technique of spraying liquid nitrogen on cancerous lesion. A multi-hole nozzle (MHN) with 5 holes is fabricated to demarcate the variation in outcome when cryogen is sprayed through customised MHN instead of conventional SHN. Special emphasis is placed on reducing the number of sitting required for completion of treatment and increasing the feasibility of cryospray process for larger lesions. Commercial SHN having a hole diameter of 0.8 mm is selected to compare results with the customised MHN having 5 holes of 0.8 mm diameter (4 holes are arranged in a circle of radius 2 mm around the central hole). Single freeze-thaw cycle is carried out to spray liquid nitrogen on tissue mimicking gel. Temperature profile accessed through infrared images advocates that lethal area formed through application of MHN is twice larger than the lethal area formed through the application of SHN on the surface of gel for same spraying distance (z). Thermocouples placed at various locations strengthen the fact that higher cooling rate (CR) corresponding to MHN ensures 15 mm spread of necrotic zone from the centre of spray (CS) and up to a depth of 2 mm from the gel surface while in case of SHN, it is limited to the vicinity of CS. On the basis of observations made through thermal images and digital images, it can be said that the ratio of lateral spread to penetration depth of ice ball remains almost same for SHN and MHN. However, the lateral spread of ice ball formed through the application of MHN is twice larger than SHN while the axial depth of ice ball does not record such increment. This reflects that MHN provides more destruction to superficial skin than SHN. Among the three spraying distances selected (i.e. z = 13 mm, 18 mm and 23 mm), the most optimised spraying distance (z) for MHN is also explored in this study. It has been found that cryoablation is not inversely proportional to the spraying distance. Spraying distance of z = 18 mm provided the most optimised result in terms of cryoablation.
Collapse
Affiliation(s)
- Prashant Srivastava
- Department of Mechanical Engineering, Indian Institute of Technology (BHU), Varanasi, 221005, India
| | - Amitesh Kumar
- Department of Mechanical Engineering, Indian Institute of Technology (BHU), Varanasi, 221005, India.
| |
Collapse
|
8
|
Chen J, LeBlang S, Hananel A, Aginsky R, Perez J, Gofeld M, Shir Y, Aubry JF. An incoherent HIFU transducer for treatment of the medial branch nerve: Numerical study and in vivo validation. Int J Hyperthermia 2020; 37:1219-1228. [PMID: 33106054 DOI: 10.1080/02656736.2020.1828628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic back pain due to facet related degenerative changes affects 4-6 million patients a year in the United States. Patients refractory to conservative therapy may warrant targeted injections of steroids into the joint or percutaneous medial branch nerve denervation with radiofrequency ablation. We numerically tested a novel noninvasive high intensity focused ultrasound transducer to optimize nerve ablation near a bone-soft tissue interface. METHODS A transducer with 4 elements operating in an incoherent mode was modeled numerically and tested pre-clinically under fluoroscopic guidance. After 6 lumbar medial branch nerve ablations were performed in 2 pigs, they were followed clinically for 1 week and then sacrificed for pathological evaluation. RESULTS Simulations show that the acoustic spot size in water at 6 dB was 14mm axial x 1.6mm lateral and 52mm axial x 1.6mm lateral for coherent and incoherent modes, respectively. We measured the size of N = 6 lesions induced in vivo in a pig model and compared them to the size of the simulated thermal dose. The best match between the simulated and measured lesion size was found with a maximum absorption coefficient in the cortical bone adjusted to 30 dB/cm/MHz. This absorption was used to simulate clinical scenarios in humans to generate lesions with no potential side effects at 1000 and 1500 J. CONCLUSION The elongated spot obtained with the incoherent mode facilitates the targeting during fluoroscopic-guided medial branch nerve ablation.
Collapse
Affiliation(s)
- J Chen
- FUSMobile, Alpharetta, GA, USA
| | - S LeBlang
- Focused Ultrasound Foundation, Charlottesville, VA, USA
| | | | | | - J Perez
- McGill University, Montreal, Canada
| | - M Gofeld
- Silver Medical Group, North York, Canada
| | - Y Shir
- McGill University, Montreal, Canada
| | - J F Aubry
- Physics for Medicine Paris, Inserm, ESPCI Paris, CNRS, PSL Research University, Paris, France
| |
Collapse
|
9
|
Characterization of performance of multihole nozzle in cryospray. Cryobiology 2020; 96:197-206. [DOI: 10.1016/j.cryobiol.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022]
|
10
|
Garcia-Sanchez T, Mercadal B, Polrot M, Muscat A, Sarnago H, Lucia O, Mir LM. Successful Tumor Electrochemotherapy Using Sine Waves. IEEE Trans Biomed Eng 2019; 67:1040-1049. [PMID: 31329545 DOI: 10.1109/tbme.2019.2928645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this work is to assess the ability of sine waves to perform electrochemotherapy (ECT) and to study the dependence of the frequency of the applied sine wave on the treatment efficacy. METHODS A subcutaneous tumor model in mice was used, and the electric field was delivered in combination with bleomycin. Sinusoidal electric fields of different frequencies, amplitudes, and durations were compared to square waves. Computer simulations were additionally performed. RESULTS The results confirmed the ability of a sinusoidal electric field to obtain successful ECT responses. A strong dependence on frequency was obtained. The efficacy of the treatment decreased when the frequency of the sine waves was increased. At low sinusoidal frequency, the efficacy of the treatment is very similar to that obtained with a square wave. The collateral effects such as skin burns and muscle contractions decreased for the highest frequency assayed. CONCLUSION The use of sine wave burst represents a feasible option for the treatment of cancer by ECT. SIGNIFICANCE These results could have important implications for the treatment of cancer in the clinical world where ECT is performed with dc square pulses.
Collapse
|
11
|
Validation of a low-cost, carbon dioxide-based cryoablation system for percutaneous tumor ablation. PLoS One 2019; 14:e0207107. [PMID: 31269078 PMCID: PMC6608927 DOI: 10.1371/journal.pone.0207107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 06/02/2019] [Indexed: 11/23/2022] Open
Abstract
Breast cancer rates are rising in low- and middle-income countries (LMICs), yet there is a lack of accessible and cost-effective treatment. As a result, the cancer burden and death rates are highest in LMICs. In an effort to meet this need, our work presents the design and feasibility of a low-cost cryoablation system using widely-available carbon dioxide as the only consumable. This system uses an 8-gauge outer-diameter needle and Joule-Thomson expansion to percutaneously necrose tissue with cryoablation. Bench top experiments characterized temperature dynamics in ultrasound gel demonstrated that isotherms greater than 2 cm were formed. Further, this system was applied to mammary tumors in an in vivo rat model and necrosis was verified by histopathology. Finally, freezing capacity under a large heat load was assessed with an in vivo porcine study, where volumes of necrosis greater than 1.5 cm in diameter confirmed by histopathology were induced in a highly perfused liver after two 7-minute freeze cycles. These results demonstrate the feasibility of a carbon-dioxide based cryoablation system for improving solid tumor treatment options in resource-constrained environments.
Collapse
|
12
|
Bosio B, Bove D, Guidetti L, Avalle L, Arato E. Numerical Simulation of the Heat Transfer in the Cryoprobe of an Innovative Apparatus for Cryosurgery. J Biomech Eng 2019; 141:2703964. [PMID: 30458504 DOI: 10.1115/1.4041526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 11/08/2022]
Abstract
Cryosurgery is a rapidly developing discipline, alternative to conventional surgical techniques, used to destroy cancer cells by the action of low temperatures. Currently, the refrigeration is obtained via the adiabatic expansion of gases in probes used for surgeries, with the need of inherently dangerous pressurized vessels. The proposed innovative prototypal apparatus aims to reach the cryosurgical temperatures exploiting a closed-loop refrigeration system, avoiding the hazardous presence of pressurized vessels in the operating room. This study preliminarily examines the technical feasibility of the cryoablation with this machine focusing the attention on the cryoprobe design. Cryoprobe geometry and materials are assessed and the related heat transfer taking place during the cryoablation process is simulated with the aid of the computational fluid dynamics software ANSYS®Fluent. Parametric analyses are carried out varying the length of the collecting tubes and the inlet velocity of the cold carrier fluid in the cryoprobe. The values obtained for physical quantities such as the temperature reached in the treated tissue, the width of the obtained cold front, and the maximum pressure required for the cold carrier fluid are calculated and discussed in order to prove the effectiveness of the experimental apparatus and develop the machine further.
Collapse
Affiliation(s)
- Barbara Bosio
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Via Opera Pia 15, Genova 16145, Italy e-mail:
| | - Dario Bove
- Faculty of Sciences and Technology, Free University of Bozen-Bolzano, Piazza Università 5, Bolzano 39100, Italy e-mail:
| | - Lorenzo Guidetti
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Via Opera Pia 15, Genova 16145, Italy e-mail:
| | - Leopoldo Avalle
- Crioelass Association, Via Murcarolo 6/9, Genova 16167, Italy e-mail:
| | - Elisabetta Arato
- Department of Civil, Chemical and Environmental Engineering, University of Genoa, Via Opera Pia 15, Genova 16145, Italy e-mail:
| |
Collapse
|
13
|
Nabaei M, Karimi M. Numerical investigation of the effect of vessel size and distance on the cryosurgery of an adjacent tumor. J Therm Biol 2018; 77:45-54. [PMID: 30196898 DOI: 10.1016/j.jtherbio.2018.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 01/04/2023]
Abstract
Cryosurgery is an efficient cancer treatment which can be used for non-invasive ablation of some internal tumors such as liver and prostate. Tumors are usually located near the large blood vessels and the heat convection may affect the progression of the ice ball. Hence it is necessary to predict the surgery procedure and its consequences earlier. In spite of the recent studies it is still unclear that which arteries will significantly affect the freezing treatment of tumors and which can be ignored. Therefore a numerical model of a spherical 3 cm diameter liver tumor, subjected to cryosurgery was developed. The specific thermophysical properties were applied to the tumor and healthy tissues in frozen and unfrozen states. A simplified Hepatic artery with different anatomical diameters was placed in different positions relative to the tumor and energy and momentum equations were solved. The temperature distribution and the shape of the resultant ice ball were discussed. The results showed that a 4 mm diameter artery in the vicinity of a tumor will increase the minimum temperature achieved at the tumor boundary by 12.5 °C and therefore significantly affects the cryosurgery outcome. This may cause insufficient freezing which leads to incomplete death of tumor cells, failure of the surgery and tumor regenesis. Eventually it was shown that injection of gold and Fe3O4 nanoparticles to the surrounding tissue of the artery can enhance the heat transfer and progression of the ice ball, making temperature distribution similar to the no vessel state. Development of computational models can provide the physicians an applicable tool which helps them recognize how efficient a treatment method will be for a specific case and design a suitable cryosurgery plan.
Collapse
Affiliation(s)
- Malikeh Nabaei
- Biomedical Engineering Department, Amirkabir University of Technology, 424 Hafez Ave, Tehran 15875-4413, Iran.
| | - Mehrdad Karimi
- Biomedical Engineering Department, Amirkabir University of Technology, 424 Hafez Ave, Tehran 15875-4413, Iran.
| |
Collapse
|
14
|
Hossain SMC, Zhang X, Haider Z, Hu P, Zhao G. Optimization of prostatic cryosurgery with multi-cryoprobe based on refrigerant flow. J Therm Biol 2018; 76:58-67. [PMID: 30143298 DOI: 10.1016/j.jtherbio.2018.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/09/2018] [Accepted: 07/09/2018] [Indexed: 11/29/2022]
Abstract
Cryosurgery is a promising novel minimally invasive surgical technique to eradicate carcinoma and non-carcinoma tissues by freezing. In this research, we applied a transient 3D two-phase refrigerant flow model inside the LN2 boiling chamber as well as a bioheat transfer model inside the tissues to evaluate the optimized ablation outcome during prostatic cryosurgery. For the evaluation of the scenarios, a defect function was used that considers non-ablated target tissue (prostate/cancer tissue) as well as ablated healthy tissue, in which the ablated tissue was evaluated using a temperature threshold. Three different configurations using three LN2 cryoprobes were analyzed during the modeling study, and the best configuration with the three LN2 cryoprobes positioned isoscelesly was found. For this configuration, temperature distributions and temperature profiles at specific points within the tissue were investigated numerically. Owing to its low computational cost, the 3D coupled model has an advantage in accurate modeling cryosurgery for curing numerous diseases.
Collapse
Affiliation(s)
- S M Chapal Hossain
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Xin Zhang
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Zeeshan Haider
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Peng Hu
- Department of Thermal Science and Energy Engineering, University of Science and Technology of China, Hefei, Anhui 230027, China.
| | - Gang Zhao
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei, Anhui 230027, China.
| |
Collapse
|
15
|
Determination of cryothermal injury thresholds in tissues impacted by cardiac cryoablation. Cryobiology 2017; 75:125-133. [DOI: 10.1016/j.cryobiol.2017.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022]
|
16
|
Chan JY, Ooi EH. Sensitivity of thermophysiological models of cryoablation to the thermal and biophysical properties of tissues. Cryobiology 2016; 73:304-315. [DOI: 10.1016/j.cryobiol.2016.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 10/20/2022]
|
17
|
He ZZ, Liu J. An efficient thermal evolution model for cryoablation with arbitrary multi-cryoprobe configuration. Cryobiology 2015; 71:318-28. [PMID: 26256654 DOI: 10.1016/j.cryobiol.2015.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/04/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
Cryoablation has been demonstrated powerful in treating of a variety of diseases, especially for the tumor ablation, which destroys the target tissue through the controlled freezing of cryoprobe. The prediction of temperature evolution during cryoablation is of great importance for developing and improving clinical procedure. This paper presented an efficient thermal model to characterize the freezing effect of cryoprobe with arbitrary layout including its size, orientation and number. The key step of the presented model is to establish a boundary heat source method to implicitly characterize the heat transfer from cryoprobe with fixed temperature or convective heat transfer boundary condition, which is furthermore incorporated to a fast parallel alternating direction explicit (PADE) finite difference method for computation acceleration. A novel dynamical and conformal computational region is designed through the shortest distance definition to balance the thermal effect of tissue and computational efficiency. The detailed test cases including a real head tissue demonstrated that the current model can accurately predict the temperature field evolution induced by arbitrary multi-cryoprobe configuration, and achieve significant computational ability due to allowable large time step (100-fold compared with the explicit finite difference method), compact computational region (at least reducing 40% number of voxels) and high parallel efficiency (speedup ratio about 8 for 12 threads) for complex tissue structure.
Collapse
Affiliation(s)
- Zhi-Zhu He
- Key Laboratory of Cryogenics, and Beijing Key Laboratory of Cryo-Biomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China.
| | - Jing Liu
- Key Laboratory of Cryogenics, and Beijing Key Laboratory of Cryo-Biomedical Engineering, Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Beijing 100190, China; Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| |
Collapse
|
18
|
An investigation of the effects from a urethral warming system on temperature distributions during cryoablation treatment of the prostate: A phantom study. Cryobiology 2014; 69:128-33. [DOI: 10.1016/j.cryobiol.2014.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 06/17/2014] [Accepted: 06/18/2014] [Indexed: 11/19/2022]
|